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Tranexamic acid use is associated with reduced intraoperative blood loss during spine surgery for Marfan syndrome



The utility of tranexamic acid (TXA) in patients with Marfan syndrome (MFS) is uncertain given associated aberrations within the vasculature and clotting cascade. Therefore, this study aimed to assess the association of TXA use with intraoperative blood loss and allogeneic blood transfusions in patients with MFS who underwent spinal arthrodesis.


We queried our institutional database for MFS patients who underwent spinal arthrodesis for scoliosis between 2000 and 2020 by one surgeon. We excluded procedures spanning < 4 vertebral levels, those using anterior or combined anterior/posterior approaches, and those involving growing rods, postoperative infection, or spondylolisthesis. Fifty-two patients met our criteria, of whom 22 were treated with TXA and 30 were not. Mean differences in blood loss, transfusion volume, and proportions receiving transfusion were compared between TXA and the control groups using Student t, chi-squared, or Fisher exact tests. Alpha = 0.05.


MFS patients treated with TXA experienced less mean (± standard deviation) intraoperative blood loss (1023 ± 534 mL) compared to the control group (1436 ± 1022 mL) (p = 0.01). The TXA group had estimated blood volume loss of 27% ± 16% compared to 36% ± 21% for controls (p = 0.05). No differences were found in allogeneic transfusion rate (p = 0.66) or transfusion volume (p = 0.15).


We found an association between TXA use and reduced blood loss during surgical treatment of MFS-associated scoliosis, suggesting that the connective tissue deficiency in MFS does not interfere with TXA’s mechanism of action.

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For their editorial assistance, we thank Jenni Weems, MS, Kerry Kennedy, BA, and Rachel Box, MS, in the Editorial Services group of The Johns Hopkins Department of Orthopaedic Surgery.


The author(s) received no financial support for the research, authorship, and/or publication of this article.

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II: Substantial contributions to conception and design; acquisition of data; analysis; interpretation of data; drafting the article; final approval of the version to be published. AM: Revising it critically for important intellectual content; final approval of the version to be published. PDS: Substantial contributions to conception and design; interpretation of data; revising it critically for important intellectual content; final approval of the version to be published.

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Correspondence to Paul D. Sponseller.

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Ikwuezunma, I.A., Margalit, A. & Sponseller, P.D. Tranexamic acid use is associated with reduced intraoperative blood loss during spine surgery for Marfan syndrome. Spine Deform (2021).

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  • Connective tissue deficiency
  • Intraoperative blood loss
  • Marfan syndrome
  • Posterior spinal arthrodesis
  • Risk modification
  • Syndromic scoliosis
  • Tranexamic acid